Extreme care needed with sodium valproate and pregnancy and women of childbearing potential

Sodium valproate should not be used:

• In girls or women of childbearing potential unless other treatments are ineffective or not tolerated.¹
• During pregnancy for the treatment of epilepsy unless there is no suitable alternative treatment.¹
• During pregnancy for the treatment of bipolar disorder.¹

As comparison, the risk of congenital malformations was highest with sodium valproate, with approximately 10–11% of pregnancies affected, followed by phenobarbital, phenytoin and carbamazepine.² There are no antiepileptic medicines risk-free when used during pregnancy.²

If pregnancy occurs, input from O&G, neurology and psychiatry is advised. A useful handout for clinicians is available.³

To prevent pregnancy two forms of effective contraception should be used by women who are taking an antiepileptic medicine; N.B. some hormonal contraceptives interact with enzyme-inducing antiepileptic medicines.²